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Unveiling patterns in pediatric appendectomy: A comparative study on healthcare resource capacity and surgical
Paulo Henrique Moreira Melo1, Luiza Telles2, Ayla Gerk Rangel3,4
1Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerias, Brazil.
Insights
Pediatric appendicitis care in Brazil predominantly occurs in hospitals with basic infrastructure, with open appendectomies being the most common surgical approach. Mortality rates were low across all facility types, indicating generally safe care provision.
Area of Science:
- Pediatric Surgery
- Healthcare Systems Analysis
- Public Health
Background:
- Appendicitis represents the most frequent surgical emergency among children.
- Assessing care quality in pediatric appendicitis within Brazil's public healthcare system is crucial.
Purpose of the Study:
- To evaluate pediatric appendicitis care in Brazil.
- To analyze the impact of hospital infrastructure and surgical techniques on care outcomes.
Main Methods:
- Data from pediatric appendicitis hospitalizations in Brazil (2022) were analyzed.
- Included patients aged 0-16 years with acute appendicitis requiring surgery.
- Hospitals were categorized by pediatric resource availability: basic, full, and pediatric facilities.
Main Results:
- 29,983 pediatric appendectomies were performed in 2022, with 90.2% being open procedures.
- Most surgeries occurred in basic-facility hospitals (53.0%), followed by full-facility (35.2%) and pediatric hospitals (11.8%).
- Full-facility hospitals had higher median costs, but mortality was low across all facility types.
Conclusions:
- Pediatric appendicitis care is concentrated in hospitals with limited pediatric infrastructure.
- Open appendectomy remains the dominant surgical method for pediatric appendicitis.
- Despite infrastructure variations, care appears safe with low mortality rates.
Background:
Appendicitis is the most prevalent surgical emergency in children. This study examined hospital infrastructure, surgical techniques, patient demographics, and hospitalization parameters to assess the provision of safe and adequate care within the Brazilian public healthcare system.
Methods:
Pediatric hospitalizations for acute appendicitis in 2022 were extracted from the Brazilian national database. We included all hospitalizations for patients aged 0-16 years with a primary ICD-10 diagnosis of acute appendicitis who underwent an operation. Parameters of interest were the type of surgical approach, mortality, and total cost of hospitalization. Facilities were defined as basic-facility, full-facility, and pediatric according to the level of pediatric resources available.
Results:
In 2022, there were 29,983 pediatric appendectomies due to acute appendicitis. Of these, 90.2% were open appendectomies. Most occurred in basic-facility general hospitals (53.0%), followed by full-facility (35.2%) and pediatric hospitals (11.8%). Full-facility hospitals had a higher median cost (USD126.3, IQR 99.5-154.4) compared to basic (USD96.8, IQR 87.6-130.1) and pediatric hospitals (USD103.0, IQR 91.9-117.5), though the cost difference between basic and pediatric was not significant (p = 0.367). Death was a rare event across all levels of hospital infrastructure and for all types of procedures performed.
Conclusions:
The majority of hospitalizations for acute appendicitis occurred in hospitals with minimal pediatric infrastructure. Open appendectomies remain the most predominant procedure across all hospital types.
